Wholesome Elderly on Mar Vista

Type of visit: Required - 1 Year

On 01/22/2026 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Required 1 year annual inspection utilizing the care tool. LPA met with Administrator Juan Ramirez and explained the purpose of the visit. LPA and Admin conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to resident bedrooms, bathroom, dining room, kitchen, common areas and backyard. LPA observed food supplies of non-perishables for a minimum of seven (7) days and perishable foods for a minimum of two (2) days. Hot water temperature was measured at 106.2 degrees Fahrenheit at the kitchen sink. The temperature in the facility was 73 degrees. LPA observed fire detectors and carbon monoxide detectors to be operable. LPA observed the fire extinguisher, located in the kitchen, was last inspected on 11/25/2025. LPA reviewed two (2) resident files, which contained all required documents. LPA reviewed three (3) staff files. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current training completed. LPA completed the full care tool and no deficiencies were observed. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 22, 2026

Type of visit: Required - 1 Year

On 03/12/2025 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Required 1 year annual inspection utilizing the care tool. LPA met with Administrator Juan Ramirez and explained the purpose of the visit. LPA and staff conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to resident bedrooms, bathroom, dining room, kitchen, common areas and backyard. LPA observed food supplies of non-perishables for a minimum of seven (7) days and perishable foods for a minimum of two (2) days. Hot water temperature was measured at 119.2 degrees Fahrenheit at the kitchen sink, which is within the required range of 105 to 120 degrees. The temperature in the facility was 71 degrees. First aid kit was completed. LPA observed fire detectors and carbon monoxide detectors to be operable. LPA observed the fire extinguisher, located in the kitchen, was last inspected on 09/14/2024. LPA conducted a file review of one(1) personnel and two(2) residents records. All files contained the required documents. LPA completed the full care tool and no deficiencies were observed. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 12, 2025

Allegation investigated: Staff did not ensure resident is receiving prescribed medication.

On 02/20/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to deliver final findings for a complaint Community Care Licensing (CCL) received on 07/29/24. LPA met with Staff Sylvia Poindexter and explained the purpose of the visit. Staff called Administraor Juan Ramirez, who was unable to make it to the facility but gave staff permisson to sign the report. During the course of the investigation, the Department conducted interviews and obtained pertinent documents relevant to the complaint investigation. Please continue to LIC9099C.. Unsubstantiated Allegation: Staff did not ensure resident is receiving prescribed medication. Interviews with facility Administrator revealed that Resident #1 (R1) was only at the facility for a couple of days. R1 moved into the facility from a room and board. Staff had picked R1 up from the room and board. When staff picked up R1, R1 did not have their medications. Per R1s Physician's Report (LIC602), they are able to manage their own medications. During this transition, facility was actively working to obtain a current medication list and medication for R1. On July 25th, 2024, Administrator Juan Ramirez had reached out to R1s social worker inquiring about R1s medication orders since they had yet to receive them. Facility Administrator did not receive a response. Facility did send R1 to the hospital due to not having their medication and was not at their baseline. R1 did not return to the facility after being hospitalized and was transitioned into skilled nursing. Based upon the information obtained during investigation, the above allegation is unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Feb 20, 2025 · control 59-AS-20240729164839

Allegation investigated: Facility staff did not dispense medications as prescribed. Facility staff left residents home alone without supervision. Facility staff did not keep accurate records.

On 01/16/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to deliver final findings for a complaint Community Care Licensing (CCL) received on 05/22/24. LPA met with Administrator Juan Ramirez and explained the purpose of the visit. During the course of the investigation, the Department conducted interviews and obtained pertinent documents relevant to the complaint investigation. Please continue to LIC9099C Substantiated Allegation: Facility staff did not dispense medications as prescribed. LPA reviewed R1s Medication Administration Record (MAR) and Medication list. LPA noted that the medication list received from the facility is dated from 2021. The MAR for February 2024 indicated that R1 only received their medication Insulin Glargine- YFGN 100 unit/ML SOPN was only given on February 11, 14, 18, 20 and 25, 2024. Per MAR the instruction for the medication is to inject 38 units under the skin daily at bedtime. There are no notes indicating why R1 was not given the medication on the other days throughout the month of February. R1s medication Novolog Flexpen 100 unit/ML SOPN is to be inject three (3) times a day before meals. R1 was not given this medication before lunch February 3, 4, 9, 13, 16, 18 and 22, 2024 as prescribed. The medication was also not given before dinner on February 4, 2024. There are no notes indicating why R1 was not given the medication on these days during those times. Based on LPAs record review, the facility did not ensure that residents were given their medication as prescribed. Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 regulations, Division 6, are being cited on the attached LIC 9099D. Allegation: Facility staff left residents home alone without supervision. On 05/30/24 LPA Ratajczak and LPA Hiratsuka arrived at the facility at 7:10AM and met with Administrator Noel Estillore. Administrator stated that the start time for the morning caregiver is 7AM and that Residents start to get up around 8 AM. The facility does have live in staff who is there throughout the night to assist residents with any needs during the nighttime. During time of LPAs visit live in staff was present at the facility but was not working that day. On 09/20/24 LPA Ratajczak conducted a case management visit at the facility. LPA conducted interviews with both staff and residents it was revealed that on the evening of 08/30/24, residents were left at the facility without supervision for about 20 to 30 minutes. Staff hours are from 8 am to 6 pm. Outside of those hours, live in staff is expected to be at the facility. Based on interviews staff left resident at the facility without supervision. Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 regulations, Division 6, are being cited on the attached LIC 9099D. Civil penalties are assessed in the amount of $500 for absence of supervision. Allegation: Facility staff did not keep accurate records. During the course of the investigation LPA reviewed Resident #1 (R1) Medication Administration Record (MAR) for February, March, April and May of 2024. LPA observed the MARs for R1 to be incomplete. For the medication Novolog Flexpen 100 unit/ML SOPN, staff did not document on the MAR the site of the injection, blood glucose and the amount given. According to the MARs from February to April, 2024, staff did not fully complete the MAR until April 10, 2024. Based on LPAs records review, the facility did not keep accurate records of the MAR. Therefore, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 regulations, Division 6, are being cited on the attached LIC 9099D. Exit interview conduct and a copy of the report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jan 16, 2025 · control 59-AS-20240522124603

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jan 17, 2025

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above facility did not ensure that residents were given their medications as prescribed. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Licensee will schedule a training with staff, topics to be covered medication administration, and how to use the MAR. Submit proof of planned training to LPA by POC due date. Once training is complete Licensee will send LPA proof of completed training by all staff.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Jan 17, 2025

87411 Personnel Requirements-General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by Based on interviews the license did not comply with the section cited above that on 08/30/24 residents were left at the facility without any staff which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Licensee is to come up with a plan and schedule to prevent this from happening. Facility will also send LPA a statement of understanding for this regulation.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(h)(4) · Plan of correction due date: Jan 30, 2025

87405 Administrator - Qualifications and Duties(h) The administrator shall have the responsibility to:(4) Recruit, employ and train qualified staff, and terminate employment of staff who perform in an unsatisfactory manner. This requirement is not met as evidenced by Based on file review the licensee did not comply with the section cited above as facility staff was not keeping accurate records of MARs.the state’s words, verbatim · CDSS document, Jan 16, 2025

Plan of correction: Licensee to write a statement of understanding of this regulation and to conduct a training by POC due date with all staff to ensure staff are following facility policies and procedures.

Type of visit: Case Management - Deficiencies

On 11/20/24, Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Graham Gunby arrived at the facility unannounced to conduct a case management visit. LPAs met with Administrator, Juan Ramirez and explained the purpose of the visit. During LPAs visit on 11/07/24 it was observed that in the backyard there is a piece of sidewalk that has lifted a couple inches due to a tree root growing underneath. This pathway is part of the facilities emergency exit. Facility does have non-ambulatory residents in care that are not able to use that pathway due to the lifting of the sidewalk. As a result of the inspection, deficiencies were observed and cited. Exit interview conducted and a copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 20, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(d)(6) · Plan of correction due date: Dec 18, 2024

87307Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities:(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above due to passageway not being free of obstruction which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 20, 2024

Plan of correction: Licensee is to fix passageway to ensure it is not obstructed. Licensee will send LPA a picture of passageway once fixed by POC due date.

Type of visit: Case Management - Other

On 11/07/24, Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Graham Gunby arrived at the facility unannounced to conduct a case management visit. LPAs met with Administrator, Juan Ramirez and explained the purpose of the visit. The facility is currently licensed for six (6) non-ambulatory, hospice waiver of six (6). During today's visit, there are five (5) residents and zero (0) resident on hospice services. During today's visit, LPA and Administrator discussed the live in staff policies, and other topics regarding residents and the facility. LPA and Administrator toured the facility to ensure the health and safety of residents in care. In areas toured, no immediate health and safety violation observed. LPA conducted interviews with residents and staff that were present at the facility. As a result of today's inspection, no deficiencies cited at this time. Exit interview conducted and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Nov 7, 2024

Type of visit: Case Management - Other

On 09/20/24, Licensing Program Analysts (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a case management visit. LPA met with Staff Jamie Mallory and explained the purpose of the visit. LPA spoke with Assistant Administrator, Juan Ramirez, via telephone call, who gave permission to have caregiver, Jamie Mallory, sign report. The facility is currently licensed for six (6) non-ambulatory, hospice waiver of six (6). During today's visit, there are four (4) residents and 0 resident on hospice services. During today's visit, LPA and Staff toured the interior of the facility to ensure the health and safety of residents in care. In areas toured, no immediate health and safety violation observed. LPA conducted interviews with residents and staff that were present at the facility. As a result of today's inspection, no deficiencies cited at this time. Exit interview conducted and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Sep 20, 2024

Type of visit: Post Licensing

On 07/31/24 Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a post licensing inspection. LPA met with staff, Jamie Mallory, and explained the purpose of the visit. LPA requested for staff to notify administrator, Noel Estillore of LPA's presence at the facility. Administrator told staff to start the inspection and they will be there soon. LPA and staff toured the interior and exterior of the facility to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, residents' bedrooms, bathroom, kitchen, garage, and backyard. LPA observed food supplies of non-perishables for a minimum of seven (7) days and perishable foods for a minimum of two (2) days. Hot water temperature was measured at 119.2 degrees Fahrenheit at the kitchen sink, which is within the required range of 105 to 120 degrees. The temperature in the facility was 80 degrees. First aid kit was completed. LPA observed fire detectors and carbon monoxide detectors to be operable. LPA observed the fire extinguisher, located in the kitchen, was last inspected on 09/15/2023. While on the tour LPA observed the cabinet under the kitchen sink to have a lock on one side but not the other. Disinfectants and cleaning solutions were inside the unlocked cabinet and accessible to residents in care. LPA conducted a file review of one(1) personnel and two(2) residents records. All files contained the required documents. LPA compared medications to those being given for one (1) residents and found no discrepancies. LPA completed the full care tool and deficiencies was observed. Please see LIC 809-D. Exit interview conducted and a copy of the report and appeal rights was provided.the state’s words, verbatim · CDSS document, Jul 31, 2024

Type of visit: Case Management - Incident

On 07/24/24 Licensing Program Manager (LPM) Laura Munoz and Licensing Program Analyst (LPA) Cheyenne Ratajczak and Grahamn Gunby arrived at the facility unannounced to conduct a Case Management Incident visit. LPM and LPAs met with Administrator Noel Estillore, and explained the purpose of the visit. The purpose of the visit is to gather additional information regarding an unusual incident/injury report that was sent to Community Care Licensing (CCL) on 07/11/2024. The report indicates that Resident #1 (R1) had called the police department and alledged that they are being abused. During today’s visit LPAs obtained a copy of R1s file and conducted interviews with staff and residents. Interviews with staff indicated that R1s recollection of the events have changed a couple of times. LPM and LPAs were unable to interview R1 due to R1 not currenly being in the facility. At this time, deficiencies are not being cited. An exit interview conducted and copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Jul 24, 2024

Type of visit: Prelicensing

On 02/22/24, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to conduct a Pre- Licensing visit. LPA met with Administrator, Chris Faamausili and explained the purpose of the visit. This application is a change in ownership (CHOW). The address is currently licensed as Elizabeth Care Homes 3, Facility #342700725. Administrator holds a current administrator certificate (#6039698740 with expiration date 06/08/24 ). The facility currently has 5 residents during today's inspection. Facility has a fire clearance for 6 non- ambulatory residents. LPA and Administrator conducted a tour of the interior and exterior of the facility. Areas toured include but are not limited to: residents bedrooms, bathrooms, kitchen, dining room and common areas. Bedrooms have appropriate furnishings. Grab bars were present in the bathroom.The facility has a food supply of, 2 days of perishable and 7 days of non-perishable food items. Smoke detectors and carbon monoxide detectors are present and operational. The Fire extinguisher was last serviced 09/15/23. All exits were unobstructed. All toxins, medications,and sharps were locked and inaccessible to residents in care. Facility's temperature was 74 degrees during todays inspection. Hot water temperature was observed to be 110 degrees Fahrenheit, which is within the regulation range of 105-120 degree. First aid kit present and maintained. LPA reviewed one (1) resident and one (1) staff file and found that all required paperwork was present . Component III was waived as the current administrator has been administrator for other RCFEs licensed by CCLD. LPA will forward findings to the Centralized Application Bureau (CAB) that facility met all the pre-licensing components. Applicant has satisfied all requirements in accordance to Title 22, California Code of Regulations on today's pre-licensing inspection. A copy of this report was provided to the facility. Exit interview conducted.the state’s words, verbatim · CDSS document, Feb 22, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 COMP II Participants: Faamausili, Chris Interview Method: Telephone interview Faamausili, Chris participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 2, 2024